medwireNews: The results of two studies published in JAMA show that real-time continuous glucose monitoring (CGM) benefits people with type 1 or type 2 diabetes with a range of insulin treatments and with a variety of backgrounds.
In an editorial published with the randomized study and the observational study, Monica Peek and Celeste Thomas, both of the University of Chicago in Illinois, USA, note that the randomized study recruited participants with type 2 diabetes, “the disproportionate barriers to had full access ”. Healthcare and health-related technology and also had disproportionately lower rates of adherence to diabetes treatment plans. “
Just over half (53%) of the 175 participants in the US study were Hispanic or Latino, African American, Asian, or other minority group; a similar proportion had less than a college degree; and less than half had private health insurance.
All participants used basal insulin to control their blood sugar levels, and other diabetes drugs were allowed with the exception of prandial insulin. Studies like the DIAMOND study have previously shown the benefits of CGM in people with type 2 diabetes using basal bolus insulin.
At the start of the study, the average glycated hemoglobin (HbA1c) values were 116 and, respectively, but after 8 months there was a significant improvement in favor of the CGM group with corresponding values of 8.0% and 8.4%.
The time in the field was also significantly higher in the participants who used CGM, with 59% versus 43% in the SMBG group (the latter measured with blinded CGM). Roy Beck (Jaeb Center for Health Research Foundation, Tampa, Florida, USA) and study co-authors note that the difference within the recommended range is an additional 3.6 hours per day.
There were no significant differences between the groups in terms of insulin dose or medication changes, leading the editors to attribute the improvements in glycemic measurements to increased patient involvement.
“Activated patients are an important part of diabetes control,” they write.
Peek and Thomas also found that the study participants rated the use of CGM positively in terms of high benefit and low effort, which suggests “the willingness of this diverse patient population to engage with the technology”.
In the observational study, Andrew Karter (Kaiser Permanente, Oakland, Calif., U.S.) and colleagues found similar significant benefits in a study of 41,753 people with type 1 or type 2 diabetes in primary care, of whom 3806 began with CGM. Their mean HbA1c levels fell from 8.17% to 7.76%, compared with 8.28% to 8.19% in 37,947 people who did not initiate CGM, a weighted and adjusted difference of 0.4% in favor of CGM application reveals what was statistically significant.
The majority of the study participants were white and were on a variety of insulin regimens, with about two-thirds using long-acting insulins.
Nine percent of CGM initiators had type 2 diabetes, and they seemed to get the most benefit from starting CGM initiators compared to non-initiators with type 1 diabetes.
Notably, 97% of participants with type 2 diabetes received a basal bolus insulin regimen, which Peek and Thomas believe is in line with current recommendations for CGM use in this group. However, they emphasize that the combined studies suggest that people with any insulin-based treatment regimen could benefit from CGM.
Taken together, these studies “make a strong statement that CGM can be a useful technology to help control diabetes in multiple patient populations,” according to the editorial.
They conclude, “It is time to expand access to CGM for patients with type 2 diabetes.”
The results of the randomized study were also presented at the ATTD 2021 virtual conference by study director Thomas Martens (Park Nicollet Internal Medicine, Minneapolis, Minnesota, USA).
medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
JAMA 2021; doi: 10.1001 / jama.2021.7444
JAMA 2021; doi: 10.1001 / jama.2021.6530
JAMA 2021; doi: 10.1001 / jama.2021.6208
